How would you code the following:
Procedure(s):
Removal Hardware 1st Metatarsal Phalangeal Joint with Reversal of Arthrodesis with Total Joint Implant Arthroplasty 1st Metatarsal Phalangeal Joint
Post-operative Diagnosis:
Arthrodesis malunion (M96.0)
Right foot pain
Arthritis right foot
Attention was directed to the right foot where prior incisions were noted medially along the 1st metatarsophalangeal joint and dorsally along the 1st interspace. A dorsal medial incision was made. Sharp and blunt dissection were carried down to the deeper tissue planes. Capsular incision was made. The extensor tendon was intact, which was retracted laterally. There was a 6-hole tubular plate with 6-screw fixation present along with 2 cross screws obliquely across the 1st metatarsophalangeal joint; these were all removed. The joint level was identified with mini fluoroscopy. The arthrodesis was transected with a sagittal saw. Next, using Arthrosurface, total joint implant technique, the joint surfaces were prepared and reamed according to manufacturer recommendations. A 9.5 mm tapered post was inserted in the 1st metatarsal. First metatarsal head component with a dorsal flange was inserted following various trials. The phalangeal component was also inserted at this time with a 4 mm poly implant. Good approximation, position and alignment was present at this time. There was good motion on the table, there was no impingement. The joint did appear somewhat unstable due to prior removal of the sesamoids. The area was copiously irrigated. Capsular repair was performed with 2-0 Vicryl suture. Subcuticular closure was performed with 4-0 Vicryl suture. Skin closure was performed with a 4-0 nylon in a running subcuticular suture fashion.
So far I've come up with 20680 and 28322. I'm not 100% sure that 28322 is the correct code but I don't know what else to use. I also can't find a code for the 1st metatarsophalangeal joint arthroplasty.
Thank you in advance.
Procedure(s):
Removal Hardware 1st Metatarsal Phalangeal Joint with Reversal of Arthrodesis with Total Joint Implant Arthroplasty 1st Metatarsal Phalangeal Joint
Post-operative Diagnosis:
Arthrodesis malunion (M96.0)
Right foot pain
Arthritis right foot
Attention was directed to the right foot where prior incisions were noted medially along the 1st metatarsophalangeal joint and dorsally along the 1st interspace. A dorsal medial incision was made. Sharp and blunt dissection were carried down to the deeper tissue planes. Capsular incision was made. The extensor tendon was intact, which was retracted laterally. There was a 6-hole tubular plate with 6-screw fixation present along with 2 cross screws obliquely across the 1st metatarsophalangeal joint; these were all removed. The joint level was identified with mini fluoroscopy. The arthrodesis was transected with a sagittal saw. Next, using Arthrosurface, total joint implant technique, the joint surfaces were prepared and reamed according to manufacturer recommendations. A 9.5 mm tapered post was inserted in the 1st metatarsal. First metatarsal head component with a dorsal flange was inserted following various trials. The phalangeal component was also inserted at this time with a 4 mm poly implant. Good approximation, position and alignment was present at this time. There was good motion on the table, there was no impingement. The joint did appear somewhat unstable due to prior removal of the sesamoids. The area was copiously irrigated. Capsular repair was performed with 2-0 Vicryl suture. Subcuticular closure was performed with 4-0 Vicryl suture. Skin closure was performed with a 4-0 nylon in a running subcuticular suture fashion.
So far I've come up with 20680 and 28322. I'm not 100% sure that 28322 is the correct code but I don't know what else to use. I also can't find a code for the 1st metatarsophalangeal joint arthroplasty.
Thank you in advance.